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Table of Contents
Frequent Symptoms
Acute vs. Chronic
Rare Symptoms
When to See a Doctor
Frequently Asked Questions
Next in Urticaria Guide
Urticariais the medical term for hives. Sometimes hives are confused for other skin conditions such aseczemaorrosacea, but their appearance and cause set them apart.
There are specific characteristics that help you identify hives. For instance, they often have well-defined borders. Hives also tend to cause itching and discomfort that’s worse at night.
Hives are a specific type of rash caused when tissues beneath the surface of the skin fill with fluid, causing raised, discolored (a change in skin tone), itchy bumps referred to as weals (or welts). Allergy is the most common cause, but hives can also occur due to an infection,autoimmune disease, or sudden changes in the environment.
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The article details the signs and symptoms of hives so that you can tell them from other types of rashes. It also explains how hives can differ based on the underlying cause and what each specific skin reaction looks like.
2:24Click Play to Learn About the Symptoms of Urticaria or Hives
2:24
Click Play to Learn About the Symptoms of Urticaria or Hives
Hives can appear on any part of the body and be as small as a pinpoint or large as a plate. They can change shape, move around, meld, disappear, and reappear over short periods of time.
Hives most often appear in the evening or early morning just after waking. They generally aren’t associated with fever, nausea, muscle aches, joint pain, or headaches unless an infection is involved.
What Causes Hives at Night?Hives are sometimes worse at night. Some evidence suggests that mast cells, the cells responsible for releasing histamine, are sensitive tocircadian rhythms, which may explain it.Allergens in bedding or temperature changes in the room could also be a factor. Hives may also seem itchier at night, when there are fewer distractions.
What Causes Hives at Night?
Hives are sometimes worse at night. Some evidence suggests that mast cells, the cells responsible for releasing histamine, are sensitive tocircadian rhythms, which may explain it.Allergens in bedding or temperature changes in the room could also be a factor. Hives may also seem itchier at night, when there are fewer distractions.
Urticaria affects up to 20% of people of all ages, races, and genders.Hives can either be acute or chronic depending on how long they last. Acute hives last for less than six weeks, while chronic hives persist beyond six weeks.
Acute urticariais more common in children and young adults.The majority areidiopathic, meaning that the cause is unknown. Acute hives tend to start and stop quickly, often lasting a few hours and rarely for more than a few days. If a cause is found, it is most often an infection, insect bite, or a drug orfood allergy.
Chronic urticariais often idiopathic and can recur over the course of months or years. In one 2013 study, 70% of people with chronic hives had symptoms that lasted for more than a year, while 14% had symptoms for five or more years. In half of the cases, no cause was found.
This photo contains content that some people may find graphic or disturbing.See PhotoHives on legs.Raimo Suhonen / DermNet / CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
Causes and Risk Factors of Hives
The look and location of hives can vary based on the cause. The appearance can sometimes give a clue as to the cause but not always.
Examples include:
All About Anxiety Rash
Rarely, urticaria can progress to a severe, all-body allergy known asanaphylaxis. Anaphylaxis affects many organ systems at once and can be life-threatening if not treated as an emergency. Hives are one of the possible features of anaphylaxis and will typically be severe.
Symptoms of anaphylaxis include:
If left untreated, anaphylaxis can lead toshock, coma, asphyxiation,cardiac arrest, and death.
If you have hives that are not severe and only cause mild itching, you can usuallytreat them at home. Most cases will resolve within a few hours to several days. If they last for more than a week or worsen, see a doctor as soon as possible.
If symptoms are recurrent, ask your doctor for a referral to either adermatologist, who specializes in diseases of the skin, or anallergist, who specializes in allergies.
Based on your symptoms and medical history, your doctor may also want to check for infections such as hepatitis B or autoimmune disorders likeHashimoto’s disease, in which hives are common.
Hives Healthcare Provider Discussion GuideGet our printable guide for your next healthcare provider’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
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Summary
Some cases have no known cause, especially with chronic hives, which can persist or recur for months and even years.
Hives occur when the immune system responds abnormally to a substance, disease, or environmental condition and triggers the release of histamine into the bloodstream. This causes blood vessels to dilate and leak fluid into the middle layers of skin. Sometimes there is no known cause.
This depends on the cause. Hives often go away on their own spontaneously and quickly. Other cases may be persistent or recurrent. Chronic urticaria is defined as daily hives lasting for more than six weeks.
Common triggers for hives include:Airborne allergensApplying direct pressure to the skin (such as wearing tight clothing)Contact allergensDrug hypersensitivityEnvironmental changes (like changes in temperature, excessive sun exposure, or extreme vibrations)ExerciseFood allergiesInsect bitesStressSome medical conditions, including HIV and hepatitis, can also make you more prone to hives.
Common triggers for hives include:
Some medical conditions, including HIV and hepatitis, can also make you more prone to hives.
Depending on the severity, your doctor may prescribe over-the-counter or prescription antihistamines to reduce itchiness and swelling. Severe cases may require a biologic drug calledXolair (omalizumab), which is approved for the treatment of chronic hives. Immunosuppressants like cyclosporine are also sometimes used off-label.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Siegfried EC, Hebert AA.Diagnosis of atopic dermatitis: mimics, overlaps, and complications.J Clin Med. 2015;4(5):884-917. doi:10.3390%2Fjcm4050884Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol.2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zChrist P, Sowa AS, Froy O, Lorentz A.The circadian clock drives mast cell functions in allergic reactions.Front Immunol.2018 Jul 6;9:1526. doi:10.3389/fimmu.2018.01526Schaefer P.Urticaria: evaluation and treatment.Am Fam Physician. 2011;83(9):1078-84.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res.2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396Tang N, Mao MY, Zhai R, et al.Clinical characteristics of urticaria in children versus adults.Zhongguo Dang Dai Er Ke Za Zhi. 2017;19(7):790-5.Ferrer M, Bastra J, Gimenez-Arnau A. et al.Management of urticaria: not too complicated, not to simple.Clin Exper Allergy. 2014;45(4):731-43. doi:10.1111/cea.12465Stepaniuk P, Vostretsova K, Kanani A.Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice.Allergy Asthma Clin Immunol. 2018;14:85. doi:10.1186/s13223-018-0310-5Kim JE, Eun YS, Park YM, et al.Clinical characteristics of cholinergic urticaria in Korea.Ann Dermatol. 2014;26(2):189-94. doi: 10.5021%2Fad.2014.26.2.189Nobles T.Dermatographism. StatPearls [Internet].Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M.Delayed pressure urticaria: a systematic review of treatment options.J Allergy Clin Immunol Pract. 2020 Jun;8(6):2035-49.e5. doi:10.1016/j.jaip.2020.03.004Harris BW, Badri T, Schlessinger J.Solar urticaria. In:StatPearls [Internet].Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol.2018 Apr;35(2):156–60. doi:10.5114/ada.2018.75237Boyden SE, Desai A, Cruse G, et al.Vibratory urticaria associated with a missense variant in ADGRE2.N Engl J Med.2016;374(7):656-63. doi:10.1056/NEJMoa1500611Park H, Kim HS, Yoo DS, et al.Aquagenic urticaria: a report of two cases.Ann Dermatol.2011;23(Suppl 3):S371-4. doi:10.5021%2Fad.2011.23.S3.S371Spickett GP, Stroud C.Does this patient with urticaria/angioedema have anaphylaxis?Clin Med (Lond). 2011;11(4):390-6.Ring J, Beyer K, Biedermann T, et al.Guideline for acute therapy and management of anaphylaxis: S2.Allergo J Int. 2014;23(3):96-112. doi:10.1007%2Fs40629-014-0009-1Dabija D, Tadi P.Chronic urticaria. In:StatPearls [Internet].Kayiran MA, Akdeniz N.Diagnosis and treatment of urticaria in primary care.North Clin Istanb.2019;6(1):93-9. doi:10.14744/nci.2018.75010
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Siegfried EC, Hebert AA.Diagnosis of atopic dermatitis: mimics, overlaps, and complications.J Clin Med. 2015;4(5):884-917. doi:10.3390%2Fjcm4050884Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol.2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zChrist P, Sowa AS, Froy O, Lorentz A.The circadian clock drives mast cell functions in allergic reactions.Front Immunol.2018 Jul 6;9:1526. doi:10.3389/fimmu.2018.01526Schaefer P.Urticaria: evaluation and treatment.Am Fam Physician. 2011;83(9):1078-84.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res.2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396Tang N, Mao MY, Zhai R, et al.Clinical characteristics of urticaria in children versus adults.Zhongguo Dang Dai Er Ke Za Zhi. 2017;19(7):790-5.Ferrer M, Bastra J, Gimenez-Arnau A. et al.Management of urticaria: not too complicated, not to simple.Clin Exper Allergy. 2014;45(4):731-43. doi:10.1111/cea.12465Stepaniuk P, Vostretsova K, Kanani A.Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice.Allergy Asthma Clin Immunol. 2018;14:85. doi:10.1186/s13223-018-0310-5Kim JE, Eun YS, Park YM, et al.Clinical characteristics of cholinergic urticaria in Korea.Ann Dermatol. 2014;26(2):189-94. doi: 10.5021%2Fad.2014.26.2.189Nobles T.Dermatographism. StatPearls [Internet].Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M.Delayed pressure urticaria: a systematic review of treatment options.J Allergy Clin Immunol Pract. 2020 Jun;8(6):2035-49.e5. doi:10.1016/j.jaip.2020.03.004Harris BW, Badri T, Schlessinger J.Solar urticaria. In:StatPearls [Internet].Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol.2018 Apr;35(2):156–60. doi:10.5114/ada.2018.75237Boyden SE, Desai A, Cruse G, et al.Vibratory urticaria associated with a missense variant in ADGRE2.N Engl J Med.2016;374(7):656-63. doi:10.1056/NEJMoa1500611Park H, Kim HS, Yoo DS, et al.Aquagenic urticaria: a report of two cases.Ann Dermatol.2011;23(Suppl 3):S371-4. doi:10.5021%2Fad.2011.23.S3.S371Spickett GP, Stroud C.Does this patient with urticaria/angioedema have anaphylaxis?Clin Med (Lond). 2011;11(4):390-6.Ring J, Beyer K, Biedermann T, et al.Guideline for acute therapy and management of anaphylaxis: S2.Allergo J Int. 2014;23(3):96-112. doi:10.1007%2Fs40629-014-0009-1Dabija D, Tadi P.Chronic urticaria. In:StatPearls [Internet].Kayiran MA, Akdeniz N.Diagnosis and treatment of urticaria in primary care.North Clin Istanb.2019;6(1):93-9. doi:10.14744/nci.2018.75010
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Siegfried EC, Hebert AA.Diagnosis of atopic dermatitis: mimics, overlaps, and complications.J Clin Med. 2015;4(5):884-917. doi:10.3390%2Fjcm4050884Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol.2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zChrist P, Sowa AS, Froy O, Lorentz A.The circadian clock drives mast cell functions in allergic reactions.Front Immunol.2018 Jul 6;9:1526. doi:10.3389/fimmu.2018.01526Schaefer P.Urticaria: evaluation and treatment.Am Fam Physician. 2011;83(9):1078-84.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res.2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396Tang N, Mao MY, Zhai R, et al.Clinical characteristics of urticaria in children versus adults.Zhongguo Dang Dai Er Ke Za Zhi. 2017;19(7):790-5.Ferrer M, Bastra J, Gimenez-Arnau A. et al.Management of urticaria: not too complicated, not to simple.Clin Exper Allergy. 2014;45(4):731-43. doi:10.1111/cea.12465Stepaniuk P, Vostretsova K, Kanani A.Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice.Allergy Asthma Clin Immunol. 2018;14:85. doi:10.1186/s13223-018-0310-5Kim JE, Eun YS, Park YM, et al.Clinical characteristics of cholinergic urticaria in Korea.Ann Dermatol. 2014;26(2):189-94. doi: 10.5021%2Fad.2014.26.2.189Nobles T.Dermatographism. StatPearls [Internet].Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M.Delayed pressure urticaria: a systematic review of treatment options.J Allergy Clin Immunol Pract. 2020 Jun;8(6):2035-49.e5. doi:10.1016/j.jaip.2020.03.004Harris BW, Badri T, Schlessinger J.Solar urticaria. In:StatPearls [Internet].Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol.2018 Apr;35(2):156–60. doi:10.5114/ada.2018.75237Boyden SE, Desai A, Cruse G, et al.Vibratory urticaria associated with a missense variant in ADGRE2.N Engl J Med.2016;374(7):656-63. doi:10.1056/NEJMoa1500611Park H, Kim HS, Yoo DS, et al.Aquagenic urticaria: a report of two cases.Ann Dermatol.2011;23(Suppl 3):S371-4. doi:10.5021%2Fad.2011.23.S3.S371Spickett GP, Stroud C.Does this patient with urticaria/angioedema have anaphylaxis?Clin Med (Lond). 2011;11(4):390-6.Ring J, Beyer K, Biedermann T, et al.Guideline for acute therapy and management of anaphylaxis: S2.Allergo J Int. 2014;23(3):96-112. doi:10.1007%2Fs40629-014-0009-1Dabija D, Tadi P.Chronic urticaria. In:StatPearls [Internet].Kayiran MA, Akdeniz N.Diagnosis and treatment of urticaria in primary care.North Clin Istanb.2019;6(1):93-9. doi:10.14744/nci.2018.75010
Siegfried EC, Hebert AA.Diagnosis of atopic dermatitis: mimics, overlaps, and complications.J Clin Med. 2015;4(5):884-917. doi:10.3390%2Fjcm4050884
Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol.2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-z
Christ P, Sowa AS, Froy O, Lorentz A.The circadian clock drives mast cell functions in allergic reactions.Front Immunol.2018 Jul 6;9:1526. doi:10.3389/fimmu.2018.01526
Schaefer P.Urticaria: evaluation and treatment.Am Fam Physician. 2011;83(9):1078-84.
Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res.2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396
Tang N, Mao MY, Zhai R, et al.Clinical characteristics of urticaria in children versus adults.Zhongguo Dang Dai Er Ke Za Zhi. 2017;19(7):790-5.
Ferrer M, Bastra J, Gimenez-Arnau A. et al.Management of urticaria: not too complicated, not to simple.Clin Exper Allergy. 2014;45(4):731-43. doi:10.1111/cea.12465
Stepaniuk P, Vostretsova K, Kanani A.Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice.Allergy Asthma Clin Immunol. 2018;14:85. doi:10.1186/s13223-018-0310-5
Kim JE, Eun YS, Park YM, et al.Clinical characteristics of cholinergic urticaria in Korea.Ann Dermatol. 2014;26(2):189-94. doi: 10.5021%2Fad.2014.26.2.189
Nobles T.Dermatographism. StatPearls [Internet].
Kulthanan K, Ungprasert P, Tuchinda P, Chularojanamontri L, Charoenpipatsin N, Maurer M.Delayed pressure urticaria: a systematic review of treatment options.J Allergy Clin Immunol Pract. 2020 Jun;8(6):2035-49.e5. doi:10.1016/j.jaip.2020.03.004
Harris BW, Badri T, Schlessinger J.Solar urticaria. In:StatPearls [Internet].
Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM.Stress, itch and quality of life in chronic urticaria females.Postepy Dermatol Alergol.2018 Apr;35(2):156–60. doi:10.5114/ada.2018.75237
Boyden SE, Desai A, Cruse G, et al.Vibratory urticaria associated with a missense variant in ADGRE2.N Engl J Med.2016;374(7):656-63. doi:10.1056/NEJMoa1500611
Park H, Kim HS, Yoo DS, et al.Aquagenic urticaria: a report of two cases.Ann Dermatol.2011;23(Suppl 3):S371-4. doi:10.5021%2Fad.2011.23.S3.S371
Spickett GP, Stroud C.Does this patient with urticaria/angioedema have anaphylaxis?Clin Med (Lond). 2011;11(4):390-6.
Ring J, Beyer K, Biedermann T, et al.Guideline for acute therapy and management of anaphylaxis: S2.Allergo J Int. 2014;23(3):96-112. doi:10.1007%2Fs40629-014-0009-1
Dabija D, Tadi P.Chronic urticaria. In:StatPearls [Internet].
Kayiran MA, Akdeniz N.Diagnosis and treatment of urticaria in primary care.North Clin Istanb.2019;6(1):93-9. doi:10.14744/nci.2018.75010
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